- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $29.51 / $97.72
| Facility | | $13.18 | $29.51 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $15.14 / $22.39
| Professional | | $5.01 | $15.14 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $56.23 / $104.71
| Facility | | $19.95 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $11.22 / $20.42
| Professional | | $5.01 | $11.22 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $20.42 / $20.42
| Facility | | $5.25 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $24.55 / $83.18
| Facility | | $5.62 | $24.55 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $9.77 / $29.51
| Professional | | $2.82 | $9.77 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $100.00
| Facility | | $97.72 | $97.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $20.42 / $38.02
| Facility | | $12.30 | $20.42 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $15.85 / $27.54
| Professional | | $6.31 | $15.85 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.98 / $16.98
| Professional | | $15.14 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $20.42 / $46.77
| Facility | | $6.61 | $20.42 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.82 / $6.31 / $21.88
| Professional | | $2.82 | $6.31 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $20.42 / $24.55
| Facility | | $3.72 | $20.42 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.63 / $6.31 / $12.30
| Professional | | $2.63 | $6.31 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.47 / $20.42
| Professional | | $7.94 | $10.47 | $20.42 |